Leading the academic library in strategic engagement with stakeholders: a constructivist grounded theory

The current diversity and disparate needs of stakeholders present significant challenges to academic libraries globally. The constructivist grounded theory presented in this paper recognizes the guiding role of the library director in responding to this problem and the need for different strategic mechanisms for engagement with various stakeholder groups. Key contributions of this work include establishing a strategic framework for engagement with stakeholders and tentative suggestions for various types of university libraries. The implications of this research include the need for outward-looking library directors, an evidence-based approach to stakeholder engagement, and the encouragement of a customer-focused organizational culture amongst staff

Micro-magnetic resonance imaging study of live quail embryos during embryonic development

Eggs containing live Japanese quail embryos were imaged using micro-magnetic resonance imaging (μMRI) at 24-h intervals from Day 0 to 8, the period during which the main body axis is being laid down and organogenesis is taking place. Considerable detail of non-embryonic structures such as the latebra was revealed at early stages but the embryo could only be visualized around Day 3. Three-dimensional (3D) changes in embryo length and volume were quantified and also changes in volume in the extra- and non-embryonic components. The embryo increased in length by 43% and nearly trebled in volume between Day 4 and Day 5. Although the amount of yolk remained fairly constant over the first 5 days, the amount of albumen decreases significantly and was replaced by extra-embryonic fluid (EEF). 1H longitudinal (T1) and transverse (T2) relaxation times of different regions within the eggs were determined over the first 6 days of development. The T2 measurements mirrored the changes in image intensity observed, which can be related to the aqueous protein concentrations. In addition, a comparison of the development of Day 0 to 3 quail embryos exposed to radiofrequency (rf) pulses, 7 T static magnetic fields and magnetic field gradients for an average of 7 h with the development of control embryos did not reveal any gross changes, thus confirming that μMRI is a suitable tool for following the development of live avian embryos over time from the earliest stages

Using co-production to increase activity in acute stroke units : the CREATE mixed-methods study

Background: Stroke is the most common neurological disability in the UK. Any activity contributes to recovery, but stroke patients can be inactive for > 60% of their waking hours. This problem remains, despite organisational changes and targeted interventions. A new approach to addressing post-stroke inactivity is needed. Experience-based co-design has successfully initiated improvements for patients and staff in other acute settings. Experience-based co-design uses observational fieldwork and filmed narratives with patients to trigger different conversations and interactions between patients and staff to improve health-care services. Objectives: To complete a rapid evidence synthesis of the efficacy and effectiveness of co-production as an approach to quality improvement in acute health-care settings; to evaluate the feasibility and impact of patients, carers and staff co-producing and implementing interventions to increase supervised and independent therapeutic patient activity in acute stroke units; and to understand the experience of participating in experience-based co-design and whether or not interventions developed and implemented in two units could transfer to two additional units using an accelerated experience-based co-design cycle. Design: A mixed-methods case comparison using interviews, observations, behavioural mapping and self-report surveys (patient-reported outcome measure/patient-reported experience measure) pre and post implementation of experience-based co-design cycles, and a process evaluation informed by normalisation process theory. Setting: The setting was two stroke units (acute and rehabilitation) in London and two in Yorkshire. Participants: In total, 130 staff, 76 stroke patients and 47 carers took part. Findings: The rapid evidence synthesis showed a lack of rigorous evaluation of co-produced interventions in acute health care, and the need for a robust critique of co-production approaches. Interviews and observations (365 hours) identified that it was feasible to co-produce and implement interventions to increase activity in priority areas including ‘space’ (environment), ‘activity’ and, to a lesser extent, ‘communication’. Patients and families reported benefits from participating in co-design and perceived that they were equal and valued members. Staff perceived that experience-based co-design provided a positive experience, was a valuable improvement approach and led to increased activity opportunities. Observations and interviews confirmed the use of new social spaces and increased activity opportunities. However, staff interactions remained largely task focused, with limited focus on enabling patient activity. Behavioural mapping indicated a mixed pattern of activity pre and post implementation of co-designed changes. Patient-reported outcome measure/patient-reported experience measure response rates were low, at 12–38%; pre- and post-experience-based co-design cohorts reported dependency, emotional and social limitations consistent with national statistics. Post-experience-based co-design patient-reported experience measure data indicated that more respondents reported that they had ‘enough things to do in their free time’. The use of experience-based co-design – full and accelerated – legitimised and supported co-production activity. Staff, patients and families played a pivotal role in intervention co-design. All participants recognised that increased activity should be embedded in everyday routines and in work on stroke units. Limitations: Communication by staff that enabled patient activity was challenging to initiate and sustain. Conclusions: It was feasible to implement experience-based co-design in stroke units. This resulted in some positive changes in unit environments and increased activity opportunities for patients. There was no discernible difference in experiences or outcomes between full and accelerated experience-based co-design. Future work should consider multiple ways to embed increased patient activity into everyday routines in stroke units

BRCA1 and MAD2 are Co-expressed and are Prognostic Indicators in Tubo-ovarian High-grade Serous Carcinoma

Additional file 1. Protein score from LC-MALDI-TOF/TOF

In vivo formation of natural HgSe nanoparticles in the liver and brain of pilot whales

Acknowledgments Z.G. thanks to the College of Physical Sciences at University of Aberdeen and Chevron USA for the provided studentship. P.M.K. is the recipient of an Australian Research Council Future Fellowship (FT120100277). Parts of this research were undertaken on the XFM beamline at the Australian Synchrotron, Victoria, Australia. The assistance of Daryl Howard (XFM beamline, Australian Synchrotron) is acknowledged. Although EPA contributed to this article, the research presented was not performed by or funded by EPA and was not subject to EPA's quality system requirements. Consequently, the views, interpretations, and conclusions expressed in this article are solely those of the authors and do not necessarily reflect or represent EPA's views or policies. MRCAT operations are supported by the Department of Energy and the MRCAT member institutions. This research used resources of the Advanced Photon Source, a U.S. Department of Energy (DOE) Office of Science User Facility operated for the DOE Office of Science by Argonne National Laboratory under Contract No. DE-AC02-06CH11357. The authors declare no competing financial interests. F.L.R. and A.B. acknowledge Scottish Marine Animal Stranding Scheme and Marine Scotland for funding. Author Contributions E.M.K and J.F. designed the experiments. Z.G. measured total Hg and conducted Hg speciation. Total Se was determined by A.R. and Z.G. M.M.L. performed Se speciation and 2D imaging by LA-ICP-MS was done by D.S.U. XANES was performed by K.S. and XRF by E.L. and P.M.K. Samples were obtained by E.M.K. through A.B. and age determination was done by F.R. spICP-MS was performed by E.H.L., K.L., G.W. and Z.G. The manuscript was written by Z.G. and all authors discussed the results and commented on the manuscript.Peer reviewedPublisher PD

Co-designing organisational improvements and interventions to increase inpatient activity in four stroke units in England : a mixed-methods process evaluation using normalisation process theory

Objective: To explore facilitators and barriers to using Experience-based Co-design (EBCD) and accelerated EBCD (AEBCD) in the development and implementation of interventions to increase activity opportunities for inpatient stroke survivors. Design: Mixed-methods process evaluation underpinned by normalisation process theory (NPT). Setting: Four post-acute rehabilitation stroke units in England. Participants: Stroke survivors, family members, stroke unit staff, hospital managers, support staff and volunteers. Data informing our NPT analysis comprised: ethnographic observations, n= 366 hours; semi-structured interviews with 76 staff, 53 stroke survivors and 27 family members pre or post EBCD/AEBCD implementation; and observation of 43 co-design meetings involving 23 stroke survivors, 21 family carers and 54 staff Results: Former patients and families valued participation in EBCD/AEBCD perceiving they were equal partners in co-design. Staff engaged with EBCD/AEBCD, reporting it as valuable improvement approach leading to increased activity opportunities. The structured EBCD/AEBCD approach was influential in terms of progressing coherence and cognitive participation and legitimated staff involvement in the process. Researcher facilitation of EBCD/AEBCD supported cognitive participation collective action and reflexive monitoring which was important in implementing and sustaining co-design activities. Observations and interviews post EBCD/AEBCD cycles confirmed creation and use of new social spaces and increased activity opportunities in all units. Changes occurred without increased staffing or organisational resource allocation. EBCD/AEBCD facilitated engagement with wider hospital resources and local communities increasing and enhancing activity opportunities. However, outside of structured group activity many individual staff-patient interactions remained task-focused with limited focus on enabling patient activity. Conclusions: Using EBCD and AEBCD facilitated the development and implementation of environmental changes and revisions to work routines which supported increased activity opportunities in stroke units providing post-acute and rehabilitation care. Former stroke patients and carers contributed to improvements. Normalisation process theory’s generative mechanisms were instrumental in analysis and interpretation of facilitators and barriers at the individual, group and organisational levels

Developing an intervention to facilitate family communication about inherited genetic conditions, and training genetic counsellors in its delivery.

Many families experience difficulty in talking about an inherited genetic condition that affects one or more of them. There have now been a number of studies identifying the issues in detail, however few have developed interventions to assist families. The SPRinG collaborative have used the UK Medical Research Council's guidance on Developing and Evaluating Complex Interventions, to work with families and genetic counsellors (GCs) to co-design a psycho-educational intervention to facilitate family communication and promote better coping and adaptation to living with an inherited genetic condition for parents and their children (<18 years). The intervention is modelled on multi-family discussion groups (MFDGs) used in psychiatric settings. The MFDG was developed and tested over three phases. First focus groups with parents, young people, children and health professionals discussed whether MFDG was acceptable and proposed a suitable design. Using evidence and focus group data, the intervention and a training manual were developed and three GCs were trained in its delivery. Finally, a prototype MFDG was led by a family therapist and co-facilitated by the three GCs. Data analysis showed that families attending the focus groups and intervention thought MFDG highly beneficial, and the pilot sessions had a significant impact on their family' functioning. We also demonstrated that it is possible to train GCs to deliver the MFDG intervention. Further studies are now required to test the feasibility of undertaking a definitive randomised controlled trial to evaluate its effectiveness in improving family outcomes before implementing into genetic counselling practice.The National Institute of Health Research funded the study but any views expressed do not necessarily reflect those of the Authority. Funded by NIHR reference number: RP-DG-1211-10015

Exploring liminality in the co-design of rehabilitation environments: The case of one acute stroke unit

This paper describes an Experience-based Co-design (EBCD) project that aimed to increase patient activity within an acute stroke unit. We apply the concept of liminality to explore ways in which the EBCD process, a form of Participatory Action Research, may challenge social hierarchies and assumptions about practices and constraints in this care setting, thereby opening up possibilities for improving the therapeutic value of the space for patients. Through the creation of an 'anti-structure' within a medicalised and bureaucratised clinical setting, EBCD enhanced a sense of community and trust between staff and patients, generating both therapeutic and social value

Locus Reference Genomic sequences: an improved basis for describing human DNA variants

As our knowledge of the complexity of gene architecture grows, and we increase our understanding of the subtleties of gene expression, the process of accurately describing disease-causing gene variants has become increasingly problematic. In part, this is due to current reference DNA sequence formats that do not fully meet present needs. Here we present the Locus Reference Genomic (LRG) sequence format, which has been designed for the specific purpose of gene variant reporting. The format builds on the successful National Center for Biotechnology Information (NCBI) RefSeqGene project and provides a single-file record containing a uniquely stable reference DNA sequence along with all relevant transcript and protein sequences essential to the description of gene variants. In principle, LRGs can be created for any organism, not just human. In addition, we recognize the need to respect legacy numbering systems for exons and amino acids and the LRG format takes account of these. We hope that widespread adoption of LRGs - which will be created and maintained by the NCBI and the European Bioinformatics Institute (EBI) - along with consistent use of the Human Genome Variation Society (HGVS)-approved variant nomenclature will reduce errors in the reporting of variants in the literature and improve communication about variants affecting human health. Further information can be found on the LRG web site: http://www.lrg-sequence.org

Therapeutic DNA vaccine induces broad T cell responses in the gut and sustained protection from viral rebound and AIDS in SIV-infected rhesus macaques.

Immunotherapies that induce durable immune control of chronic HIV infection may eliminate the need for life-long dependence on drugs. We investigated a DNA vaccine formulated with a novel genetic adjuvant that stimulates immune responses in the blood and gut for the ability to improve therapy in rhesus macaques chronically infected with SIV. Using the SIV-macaque model for AIDS, we show that epidermal co-delivery of plasmids expressing SIV Gag, RT, Nef and Env, and the mucosal adjuvant, heat-labile E. coli enterotoxin (LT), during antiretroviral therapy (ART) induced a substantial 2-4-log fold reduction in mean virus burden in both the gut and blood when compared to unvaccinated controls and provided durable protection from viral rebound and disease progression after the drug was discontinued. This effect was associated with significant increases in IFN-γ T cell responses in both the blood and gut and SIV-specific CD8+ T cells with dual TNF-α and cytolytic effector functions in the blood. Importantly, a broader specificity in the T cell response seen in the gut, but not the blood, significantly correlated with a reduction in virus production in mucosal tissues and a lower virus burden in plasma. We conclude that immunizing with vaccines that induce immune responses in mucosal gut tissue could reduce residual viral reservoirs during drug therapy and improve long-term treatment of HIV infection in humans